Gateway health and education assessments

As a result of their backgrounds, kids who come into care are often disconnected from regular health and education services, and are more likely to have physical, behavioural, and emotional barriers to overcome. Often the complexity of problems means that no single agency is able to provide the full package of care and services required. 

Identifying and responding to children and young people’s health and education needs is a critical step in enabling them to thrive.

In May 2011, the Government announced a $43m funding package to improve services for children in care.  This included funding for Gateway Assessments, the expansion of mental health services, early childhood education and specialised parenting support.

The Gateway Assessments aim to ensure every child or young person entering care receives an assessment that helps build a complete picture of the child or young person's needs, and sees that they get access to the right health and education services to address their needs.

Gateway Assessments will be available to:

• every child or young person entering care (around 2,200 per year)
• children and young people already in care, to help identify ways to address their health and behavioural needs (around 500 per year),
• children and young people who are being referred for a Family Group Conference and it would help clarify and identify ways to address their needs. (around 1,500)

The implementation of Gateway Assessments is underway, beginning with the areas involved in the pilot-project.  They will be fully in place nationwide by December 2012.

Between 2008 and 2010, Child, Youth and Family and the Ministries of Health and Education have been piloting health and education assessments across four district health boards – Auckland, Counties Manukau, Lakes, and Mid Central, alongside 16 Child, Youth and Family sites. 

A review of the pilots showed, on average, three more health needs per child were identified as a result of the assessments.  Information from our pilots is consistent with international research, and showed that of the children who came into our care:

• Approximately 65 percent have mental health or behavioural problems
• 40 percent of these are likely to need specialist services. Currently only around seven percent receive specialist mental health services
• 15 percent suffer from developmental delay
• 37 percent have impaired hearing
• Around 40 percent need dental care or help with skin conditions.

Many have a combination of health and education needs and, in 88% of cases, had problems that had gone unidentified or untreated prior to them coming into care. 

A review of the pilots show that, on their own, social workers are generally able to identify around two health needs per child, whereas the gateway process identifies on average five needs per child.  Benefits of the Gateway Assessment include:

• families gain new insight into their children's behaviour that they'd not previously understood.
• connecting these children to the primary and specialist health services they need
• better information for teachers so they can help them in the classroom
• more integrated information across agencies strengthens relationships, leading to more informed planning and service development
• the child or young person has a better understanding about their needs and what help is available to them.

The health assessment is usually undertaken by a pediatrician or youth health specialist. Teachers from the child or young person's school or early childhood education centre also provide a profile of their education engagement and achievement.

The Gateway Assessment coordinator, employed by the DHB, has oversight of the process.  They gather together the information from the social worker, family, health assessor and teacher, and seek agreement on the Interagency Services Agreement, which outlines what part each agency will play in meeting the needs of the child or young person.  

The Gateway assessments process involves:

• The Child, Youth and Family social worker will explain the Gateway Assessment process to the child, young person and their family.  They will also gain appropriate consent to make the referrals for a comprehensive health assessment and education profile
• The Gateway Assessment Coordinator collects existing health information, including the family health history, and receives the education profile completed by the teacher
• They also arrange the health assessment of the child or young person, and send the collected information to the assessor
• The Health Assessor undertakes a comprehensive health assessment with the child or young person and their supporting adult/s, and reviews the background information 
• They then write up a report on recommendations to address the child or young person’s health needs, which is used to inform the development of the Interagency Services Agreement
• The Gateway Assessment Coordinator, social worker, health assessor and teacher discuss and agree what services can be offered to the meet the child or young persons needs
• The proposed services are discussed with the child or young person and their family and caregiver and, if agreed (perhaps at Family Group Conference), services are provided to address the child or young person's needs.

By working together, we are able to build a complete picture of the child's needs and make sure they get access to the right services.